CurrentPremera BluecrossPolicy cmi_ 171624

Modifier JW and Modifier JZ — Drug amount discarded/wasted and zero amount discarded

Defines when Premera recognizes HCPCS modifier JW (amount discarded/wasted) and JZ (zero amount discarded) for single‑use drug vials/packages on professional and facility claims and the billing/documentation requirements for providers.

Policy Summary

PayerPremera Bluecross

PolicyModifier JW and Modifier JZ — Drug amount discarded/wasted and zero amount discarded

Policy CodePolicy cmi_ 171624

Change TypeAdded JZclarified JW guidancebilling/unit rules clarified

Effective Date

Next Review Date

Key ActionAppend modifier JW to report discarded/wasted units and submit a separate claim line for wasted units; use JZ when no portion was discarded.

SourceLink

POLICY UPDATE CHANGES

Created a new section 'Suppliers of Drugs' describing billing when provider supplies/dispenses but does not administer drugs.

Removed the phrase stating reimbursement for waste will be reduced to match the dose of the smallest vial available (previously added 11/12/24).

Added Modifier JZ (zero amount discarded) section and clarified correct usage of JW and JZ modifiers.

Clarified that fractional units for administered or wasted drug billing are not valid and will not be accepted.

two claim linesrequired when billing administered plus wasted drug amounts

single claim linerequired when drug fully administered with no wastage (JZ)

04/07/25last approval/review date

annualreview cadence

Coverage criteria for JW and JZ billing

Coverage criteria for JW/JZ billing

Covered when ALL of the following conditions are met:

Policy applies to single‑use vials or single‑use packages only; multi‑dose vials are not eligible for JW or JZ reporting.

ALL of the following

Documentation in the member's medical record must specify the number of units administered and the number of units discarded/wasted.
The administered portion must be billed on one claim line with the appropriate HCPCS procedure code and NDC; the wasted portion must be billed on a separate claim line with the same HCPCS and modifier JW and include NDC details.

ALL of the following

Policy Summary

PayerPremera Bluecross

PolicyModifier JW and Modifier JZ — Drug amount discarded/wasted and zero amount discarded

Policy CodePolicy cmi_ 171624

Change TypeAdded JZclarified JW guidancebilling/unit rules clarified

Effective Date

Next Review Date

Key ActionAppend modifier JW to report discarded/wasted units and submit a separate claim line for wasted units; use JZ when no portion was discarded.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Codes and unit billing rules

HCPCS NOC codesHCPCSCovered

J3490	HCPCS NOC drug procedure code — JW/JZ required reporting when applicable
J3590	HCPCS NOC drug procedure code — JW/JZ required reporting when applicable
C9399	HCPCS NOC drug procedure code — JW/JZ required reporting when applicable

Fractional unit billing (operational rule)

Operational ruleFractional units for administered or wasted drug are not valid and will not be accepted.

Combined units requirementThe combined total of billed administered and wasted units must equal the total number of units in the single‑use vial or package.

Smallest-dose correspondenceUnits billed should correspond with the smallest dose (vial) available that could provide the appropriate patient dose while minimizing waste.

Excessive wasteWhen a larger vial is used and excessive waste results, the excess waste will not be reimbursed.

NDC requirementNDC number, quantity administered/wasted, and basis of measurement (mg/mL/etc.) are required on claims for reimbursement.

Billing steps and modifier usage

Billing Rule

Modifier JW — wasted/discarded portion

Append modifier JW to the HCPCS drug procedure code when a portion of a single‑use vial or single‑use package is discarded, wasted, or not administered to any patient. JW is valid ONLY for single‑use vials/packages — do NOT use JW for multi‑dose vials intended for multiple patients. When JW is used, the medical record must document both the amount administered to the member and the amount discarded/wasted. The administered portion must be billed on one claim line with the appropriate HCPCS code and NDC; the wasted portion must be billed on a separate claim line with the same HCPCS code appended with modifier JW.

JW applies only to single‑use vials/packages — not to multi‑dose vials
Medical record must specify units administered and units discarded/wasted
Administered portion billed on one claim line with HCPCS + NDC; wasted portion billed on a separate claim line with the same HCPCS + modifier JW

Billing Rule

Claim submission for wasted drugs

When submitting claims that include wasted drug amounts, submit two separate claim lines: one for the portion administered and one for the portion wasted. For the administered line submit the HCPCS code for the drug (no JW modifier), number of HCPCS units administered, billed amount, and the NDC number with NDC unit quantity and basis of measurement. For the wasted line submit the same HCPCS code appended with modifier JW, number of HCPCS units wasted, billed amount, and the NDC number with NDC unit quantity and basis of measurement. The patient medical record must clearly indicate the number of units administered and the number of units discarded. Billing fractional HCPCS units for either administered or wasted portions is not valid and will not be accepted. The combined billed units for administered + wasted must equal the total units in the single‑use vial/package. Excessive waste from using a larger‑than‑necessary vial will not be reimbursed.

Claim line #1: HCPCS for administered (no JW), number of units administered, billed amount, NDC, NDC unit quantity, NDC basis of measurement
Claim line #2: Same HCPCS appended with JW, number of units wasted, billed amount, NDC, NDC unit quantity, NDC basis of measurement
Do not bill fractional HCPCS units for administered or wasted portions; combined units must equal the vial/package total
Use the smallest vial size that can provide the appropriate dose to minimize waste; excessive waste from larger vials is not reimbursed

Billing Rule

Claim submission for no wastage (modifier JZ)

If the entire single‑use vial or single‑use package was fully administered with no wastage, append modifier JZ to the HCPCS drug procedure code and submit a single claim line. Include the NDC number, NDC unit quantity, and NDC basis of measurement for the drug administered, the number of HCPCS units administered, and the billed amount. The medical record must document that the total number of units in the single‑use vial/package were fully administered with no wastage. Do not report JW when there was no wasted portion.

Single claim line: HCPCS code appended with JZ, NDC number, NDC unit quantity, NDC basis of measurement, number of HCPCS units, billed amount
Medical record must confirm zero wastage — entire single‑use vial/package administered
Do not append JW when there is no wasted portion

Modifier definitions

Modifier JW — definition

MeaningModifier JW indicates the discarded/wasted or non‑administered portion of a drug when appended to the HCPCS procedure code for a single‑use vial or package.

ApplicabilityValid ONLY for single‑use vials/packages; not appropriate for multi‑dose vials.

Claiming guidanceWhen used, documentation in the medical record must specify units discarded/wasted and units administered; administered portion billed on one claim line and wasted portion billed on a second line with JW.

Modifier JZ — definition

MeaningModifier JZ indicates zero amount discarded/not administered to any patient — i.e., the entire single‑use vial or package was administered.

ApplicabilityValid ONLY for single‑use vials/packages; not appropriate for multi‑dose vials.

Claiming guidanceWhen JZ is used, submit a single claim line with the HCPCS procedure code appended with JZ and include the NDC and total quantity administered for reimbursement.